A clear vision: Eye care for children and young people in special schools in Wales Nathan Davies September 2012 With thanks to the Welsh Government, Dr Maggie Woodhouse, Dr Barbara Ryan, Nicola Crews and Aideen McAvinchey

Structure of presentation Overview of the special school project Key results and case studies Feedback from schools and parents Summary of recommendations

Overview of the project Funded by the Welsh Government as part of the Children's Low Vision Project in Wales Five special schools took part in the pilot project: Maesgwyn School Aberdare Ysgol Heulfan Y CanolWrexham Crownbridge School Pontypool St.Christopher's School Wrexham Portfield School Haverfordwest

Optometrist carried out sight tests in school with all pupils who had consent to take part. Glasses prescribed and referrals made when required. Overview of the project (2)

Key results

Pupils who participated 152 pupils had a sight test Aged between 3 years 6 months and 22 years (mean: 13 years) 43 pupils (28.3%) were of primary age (under 12 years).

Previous history/ consultations Previous consultationNumber of pupils % of total pupils who had sight test No previous consultation 58 38% Local optometrist 62 41% Hospital clinic 32 21% Total152100% Over one third of pupils had never had a sight test.

Prescription of glasses Overall: –53% (80 pupils) received a prescription for glasses –47% (72 pupils) did not need a prescription for glasses.

Prescription of glasses (2) % (number of pupils) Reason for prescription % (number of pupils) Glasses not prescribed 48% (72)n/a Glasses prescribed 53% (80)First time prescription 24% (36) Change in prescription 15% (23) New pair because of wear and tear 14% (21) Total100% (152) 53% (80)

Pupils with visual impairment/ low vision The survey showed that 6% of pupils had visual problems recorded as a primary or secondary need in their statement of special educational need. The project found: –Overall, 20% of pupils (30) had visual impairment in their habitual state (0.3 or 6/12 or poorer)

Pupils with ocular or eye movement disorders Of 151 pupils, 47% (71 pupils) had at least one ocular disorder, e.g. –27% (41 pupils) were found to have blepharitis (inflammation of the eye lids) 10.5% (16) of pupils had nystagmus 24.5% (37) of pupils had strabismus (squint)

Case study 1 Pupil A is 15 years old, is severely autistic and has Down’s syndrome. Mum had taken A into a community optometry practice 2 years before but they were asked to leave the practice as the child’s behaviour was upsetting other patients. Since then, A has had no form of glasses despite needing a high prescription for long-sight and astigmatism. Mum was so embarrassed that she had almost resorted to buying A glasses online rather than going to an optometrist.

Case study 2 The school has been struggling to get an appropriate head rest for pupil D (who was 15 years old) but, unfortunately, due to lack of communication between the different professionals, his nystagmus had never been considered. The head rests in question were placed at a point maximising the nystagmus and his head had been strapped in place. This may have induced oscillopsia (perception that the world is moving). D had been trying to pull his head in the opposite direction.

Feedback from schools Brilliant project, please come back next year ! A worthwhile project that the school has been very happy to take part in. Please can we have you back on an annual basis? This has been such a benefit for our pupils. We were delighted to be part of the programme and feel that it has had excellent outcomes for our pupils and staff.

Feedback from parents A big thank you to all the project team. It's been a great project. Our child asks for their glasses first thing in the morning and has adapted very well to wearing them. We've noticed a huge improvement in her behaviour since she was prescribed glasses. School has noticed that her behaviour has improved. The whole project was very professional but was also child-friendly. Children are more receptive and relaxed in school. It's a brilliant idea to test them in school and we look forward to taking part in the future.

Summary of recommendations An optometric service should be provided to pupils in special schools. –Optometrists accredited to provide one or more of the Welsh Eye Care Services should be offered training and accreditation to provide the service in special schools. –A trained optical assistant or dispensing optician should accompany the optometrist. –A central administration team should book appointments and order spectacles and equipment. –Optometrists testing in special schools should link with school nurses.

Thank you very much. Diolch yn fawr. Nathan Davies Children's Low Vision Advocate for Wales